Blue Cross® Preferred HMO Silver - 70

2017 plan year

Overview

About this plan

With this plan, you choose a primary care doctor who refers you to other doctors in our wide HMO network. It's good for people who want to pay a little more each month in order to pay less at the doctor. If you're eligible for a subsidy, this plan could be more affordable than you think.

Coverage level

This is a Silver 70 plan. That means it covers about 70 percent of your health care costs. Depending on your income, you may be eligible for a silver plan that covers more of your costs. Find a plan to see if you qualify.

Monthly premiums

To give you an accurate price, we'll need some information. Find a plan to get a quote.

Deductible

If you have a family plan, and one member meets the individual deductible, Blue Cross will start paying covered benefits for that member only. The remainder of the family deductible has to be met by the remaining family members before Blue Cross will start paying covered benefits for the rest of the members on the plan.

In network

Out of network

Not covered

Out-of-pocket maximum

If you have a family plan, and one member meets the individual out-of-pocket maximum, Blue Cross will start paying 100% of the approved amount for covered benefits for that member only. The remainder of the family out-of-pocket maximum has to be met by the remaining family members before Blue Cross will start paying 100% of the approved amount for covered benefits for the rest of the members on the plan.

In network

Individual: $6,350
Family: $12,700

Out of network

Not covered

Office visits

Primary care

You pay $30.

Specialist

You pay $50 after deductible.

Urgent care center

You pay $40.

Emergency room

You pay $250 after deductible, then 30%.

Prescriptions

Copays start at $4 after deductible. See the prescription tab for more details.

Dental

This plan doesn't include dental coverage. See the dental tab for more details.

Vision

This plan only includes vision coverage for children. See the vision tab for more details.

Related documents

For even more details about this plan, see the Certificate of Coverage (PDF). Certificates are legal documents that describe the benefits of a health insurance plan. Your plan might have different benefits and limitations than those listed in this document.

Outpatient substance use services

In network

You pay $30 after deductible.

Out of network

Not covered

Prescriptions

In-network benefits

Using an in-network pharmacy will help keep your costs as low as possible. You can get 30- or 90-day prescriptions from retail or mail-order pharmacies. You can get 60-day prescriptions from mail-order pharmacies only. Find a pharmacy.

Out-of-network benefits

This plan doesn't cover prescriptions you get at an out-of-network pharmacy.

Notes

Depending on the health care services you need, your provider might have to get approval before providing that service. Use our website to find more information and a list of services that need approval.

Estimated pricing information for various procedures by in-network providers can be obtained by calling the Customer Service number listed on the back of your BCN ID card and providing the procedure code. Your provider can also provide this information upon request.